Meet Roberto, quite an eye-catching avatar who is one of the more interesting characters that can be found frequenting random areas of the Second Life world that we explore from day to day. Above Roberto’s head is a floating, spinning, square picture of his real-life self. This floating image of himself is something he calls a “tip hat”, where people can pay a small donation to receive a party hat, and witness Roberto doing a dance in return for their kindness. Some of the contributions Roberto receives go toward the cause of making his avatar look as much as possible like his real self. This, however, raises a few questions: Isn’t there an easier way to raise the money? Why is it so important for him to look like his real-life image? And what’s his motivation for setting out on such a time-consuming and ultimately unrewarding task? The answer is simple: Agoraphobia.

Roberto Salvatierra, aka SL resident Roberto Salubrius, is a medical student from San Jose, Costa Rica, who suffers from the fear of open places and being out in public that is known as agoraphobia. He told me that at first, his main reason for making his avatar resemble his real-life image as closely as possible was to help him in curing his affliction. By seeing himself in a simulated 3D environment, Roberto feels he can become more comfortable with unfamiliar open spaces. If we were to look at this as a meaningless exercise, however, we would be mistaken. Speaking of the real impact of the Second Life environment on his first life condition, Roberto recalled his initial experience of the virtual world: “When first I came in here, I teleported to a forest, then I fell over a hill, running. At that exact moment, I got so anxious, I felt like I was there, running down the hill. But the anxiety came down fast as soon as I felt that I was in my house at a safe place, so I thought okay, the real problem is actually my perception of my environment.”

There are many misconceptions about agoraphobia: that it’s caused by lack of intelligence, or a lack of courage. Roberto is lacking in neither of these things. He is a member of Mensa, and has fought his illness to attend medical college, where he is the top student in his class. Speaking of these misconceptions, he explained to me that “agoraphobia is a condition [that] not many people understand. They think that we don’t do things just because we don’t want to. It’s a condition, a disease, it needs to be treated and cured. It’s not about courage. For instance: you can’t go out and tell a diabetic, ‘Hey man, make your pancreas make more insulin.’ The problem is that [with] a diabetic you can test their blood sugar, and see that it is up. There is no test to see if you have agoraphobia, so even your family thinks it’s lack of courage, but it’s not, we are sick. People just don’t get it.”

Interview with the agoraphobic

Roberto explained to me that unfortunately for him and people like him, agoraphobics don’t have support groups like alcoholics because of the nature of the condition. He has found that the internet is a great resource in bringing agoraphobics together, which is why he set up a website for people like himself to talk about it. But now he feels that a 3D environment like Second Life can “go way beyond that”. Being interviewed on the issue for a Columbian national newspaper, among other things, has made Roberto an important spokesman for the treatment of agoraphobia using the Internet.

With the money that he has raised so far in Second Life he has set up an in-world group called the “Agoraphobia Support Group” which he hopes other people with agoraphobia will join to discuss their shared difficulties. In the long term, with the money he raises through his tip hat project, he hopes to perhaps buy a small section of land in Second Life to build a place where agoraphobics can go to share ideas on this pioneering method of fighting this illness.

So if you see an avatar that resembles a Costa Rican man in his underwear, smoking a cigarette with a spinning picture over his head, it’s more than likely Roberto! The work that he’s doing within Second Life could certainly be seen as pioneering and has the potential to help a lot a people with a very difficult condition. So throw a few Lindens his way, you could really be helping someone — and the dance is too good to pass up!

14 Responses to “Interview With the Agoraphobic: Fighting the Fear in Second Life”

Urizenus

Feb 4th, 2007

Great story.

Tyke Lamont

Feb 4th, 2007

Good material. While I am not one to suffer from agoraphobia, my first thought in Second Life has been that I wanted to make my avatar look as closely as my first life image as possible. So far I have been averagely successful with even free body parts/skins, although the lack of wide variety of beards and the need to have them painted on the model rather than being 3D is making it very difficult.

Might be off topic here, but do people here know of any good beard modellers in-game?

Outstanding article, Aidan. I wonder how many people are out there like Roberto, using SL as a simulation to help improve their ability to function in RL. Now all we need is a story like this in a peer-reviewed scientific journal.

I agree that Second Life offers some impressive capabilities for helping people with various health issues and psychological conditions.

My problem with this article is the premise that underlies a good deal of mass talk about health on the Internet especially. In this worldview, the adherents posit in a facile way that a complex condition, made up of a variety of psychological constraints, conditioning, traumatic stress reactions, possibly mixed with very physical features as well, i.e. some gene, or some chemical imbalance is in fact “only a disease”. The “only disease” stuff is a bid to get the conditional “mainstreamed” and “Normalized” and to absolve them and society from having to look deeper.

But in fact, they don’t always have demonstrable proof of any scientific sort that their condition is in fact physically based and a physical disease that involves simple treatment. That is, if some chance experiment here or there showed some part of the brain lighting up in those individuals who suffer that condition, it might merely mean that the brain adapts to psychological conditioning over time into the appearance of physical origins.

You could only tell the difference between actual physical ailment and conditionalized ailment by blunt scenarious like a house on fire: a person who has a broken leg, or who is on a dialysis machine, or who is a paraplegic, will not be able to run from the house, full stop. A person with agoraphobia may run once the flames lick at their feet.

That doesn’t mean that it is “all in their head” or “they aren’t brave enough”. It means that these conditions are complex, and simplifying them and giving them all the name of “disease” can be misleading. (Alcoholics, for example, have perfected the disease theory of their condition to a science, but never question that the main thing causing the symptoms of their disease — alcohol — if removed completely by force or law, might end their “disease” in a jiffy lol.)

Agoraphobia is an anxiety disorder, basically, and most writing on it doesn’t claim that it is some sort of chemical imbalance or gene malfunction, but a psychiatric illness (http://en.wikipedia.org/wiki/Agoraphobia) Having had relatives and colleagues with this syndrome, I don’t at all minimize its reality or its suffering. Yet I won’t accept an argumentation that says it is merely a disease like heart disease, when it is a complex set of factors having to do more with a conditionalized pre-anticipation of becoming panicked and becoming embarrassed in either a closed or open space (it’s not actually about the space). It is helped through cognitive and anti-depressant therapy; I’ve seen this have dramatic results in some cases, and in others not have any effect (merely proving my point that what people experience with psychiatric illnesses isn’t a pat “disease” fixable by a “drug” or a “therapy” the way a broken leg or pancreas are fixed, but something much more complex).

It appears to be a syndrome. And we could argue about whether the best therapy is to go on the anonymous and protective Internet, as big an agora, or marketplace, as it is. Because ultimately, even with a realistic avatar, you are sitting at home. It could actually be a placebo and a distraction to real, helpful therapy.

>Now all we need is a story like this in a peer-reviewed scientific journal.

Pathfinder,

Let’s hope that people do some peer-reviewing and scientific analysis of the claims here, and don’t just drink the Linden Kool-Aid, which often makes the very emotional and seemingly unassailable claim that Second Life helps the disabled. Who could question these claims without sounding like they are against helping the handicapped?!

Well, I do. Let’s take a group of people actually suffering from agoraphobia. Or let’s take a group of people who are caregivers for schizophrenics.

And let’s actually do a double-blind, peer-reviewed critical study with real science, not pseudoscience.

Let’s devise some actual scientific metrics. Compare therapies given in the normal way to agoraphobics, and compare those who are exposed to 2 hours or 10 hours or whatever works, to Second Life simulation, which are going to ostensibly provide “healing”.

Let’s compare training to caregivers in the traditional way, using literature, artwork, and interviews with patients to help them understand schizophrenia, and compare training using a simulation in SL for what it’s like to be a schizophrenic.

I’ll bet that the outcomes will show that the contrasting therapies or trainings provide *no measurable difference* (just like any studies with “serious games” point to the same thing often). But everyone will emotionally agree that Second Life is “more fun”. Then you can only hope that whoever is in charge of the budget and purchase orders will be able to prevail on his colleagues if they are overlooking the cost of new computers, graphic cards, bandwidth, land and most importantly — *time*.

In other words, the task isn’t just to find some friend on a medical journal, or some science writer in a mass media publication, and get them to come to Jesus and put in this article in an ecstatic, religious, sort of unscientific way. The task is to get people seriously examining the ecstatic claims and doing serious peer-reviewed work on these claims. It might actually show that Second Life is a vast distraction and a fake. If you are a scientist, you’ll have to accept that outcome.

Seola Sassoon

Feb 4th, 2007

I’ve actually long said in the battle of ‘endless gamers’ and their lives, that gaming in any sort allows them social contact which could therefore remove a level of isolation in diseases such as this. There have been a few very small controlled studies in the US from people that have extreme social anxiety who perform well in MMO’s. Some of these people after being able to ‘blossom’ so to speak in social circles such as clans have slowed moved to the ‘real world’.

It’s not scientific in any sort, or by any means, but it does make for an interesting discussion, especially in the console gamers versus PC/MMO gamers. SL opens up avenues of making money to people who can’t handle working in loud, noisy jobs (which most are unless you are a librarian), and I think that’s a neat concept as well.

I myself, can’t handle being in the jobs that are currently available to me (and no I’m not claiming disease or anything of the sort), but the loudness, the immaturity in having to work near people my age, and all that good stuff, leaves me open to work in SL in relative peace.

hotlips Tornado

Feb 5th, 2007

“Now all we need is a story like this in a peer-reviewed scientific journal.”

Pathfinder, I know you guys got some stick for your research ethics policy, and I’m pleased to see that you seem to have removed it. However, the vacuum it leaves is perhaps not encouraging for research groups who need be to sure that, if they embark on a project in SL, the ToS will not change and pull the rug from under them while they’re halfway through, or that LL will shy away from confonting the as-yet unexplored issues that will arise if SL is to be a valid platform for research.

Perhaps you should make some official statement on the website saying something along the lines of “We support and encourage research within SL and will defend SL researchers. In particular, we will not stop research activities that have been passed by a recognised research ethics committee unless ordered to do so by a court”. For example, I’m currently planning a project looking at how people adjust to chronic pain. Now I know that some people with chronic pain self-medicate with illegal drugs. If I was to be running this project within SL then I’d want some kind of a guarantee that you wouldn’t just pull the whole thing if you got a sniff of a complaint that it was promoting illegal activity. (If you do have such a statement then I haven’t found it yet).

This problem, for me, isn’t just restricted to SL.

Very interesting article. I do hope Roberto makes some good progress with the work he’s doing.

Second Life Herald: Interview With the Agoraphobic: Fighting the Fear in Second Life

This is just a brief note to point out this interesting post about a novel application of virtual reality to healthcare in the Second Life Herald: Interview With the Agoraphobic: Fighting the Fear in Second Life. It’s apparent that healthcare

ayman

Dec 18th, 2007

hi im facing agoraphobia since 5 years ago i cant go more than 1 km im 23 years old im stuck im faCING A BAD FINENTIAL SUCOMSTANCES AND OTHERS I DONNA KNOW WHAT TO DO I BEG YOU TO HELP ME IF YOU COULD BY THE WAY IM TSAKING EFEXOR XR SINCE A YEAR AND A HALF AGO HOPE TO REQUEST AYM

miagirl1122

Mar 4th, 2008

How about taking condecsending “cures” and washing them again, again…well, you know, the boring pooping problem. People with OCD problems, here is a self tried and true cure…say to yourself the next you see, add, do anything you know the feeling, your mother, father, child will die. It’s in your head…Anything that’s painfull and hatefull, I know, just say to yourself “if I do or think like that again for 24 hours my (child, mother, grandmother, dad) will die.” You can’t not do it.

carina carina

May 19th, 2008

can you tell me a real tratment for agoraphobia?i have it and its stil with easy symptoms.can u help me make it more comfortable or to dissapear?excuse my english,i am from romania

Joanna Deckman

Jul 21st, 2008

I currently am suffering from agoraphobia and havent left my home in over a year. I seem to not be able to get out and get the help that i need because of my panic attacks. I just need someone that has the same thing i have to help me understand it better and try and control the panic so i can get out and do things. I feel that it has taken over my life, and i want to get through this so i can get my life back.

Isobel

Jun 22nd, 2010

The trouble is that those in the medical profession think they know more than they actually do about agoraphobia. They come with a preconceived idea that it’s an anxiety disorder, that the anxiety came first and caused the agoraphobia, whereas in many cases it was the agoraphobia that caused the anxiety. In my own case, I was totally happy when agoraphobia struck without warning – I had a loving family, a great job, plenty of friends and a full social life. But when I found that every time I went out in public, every time I even walked down the street, I felt faint and dizzy and on the point of passing out, then naturally I felt anxious – who wouldn’t? The anxiety part of agoraphobia is easy to understand; remove the agoraphobia and the anxiety will go, not the other way around.

I just wish those who study this illness could think outside the box for a moment, instead of talking nonsense about anxiety and stress causing agoraphobia and how such and such a therapy should be used to treat it. If they’d only listen to people who suffer from it, listen properly and without their head filled with preconceived notion, they might actually learn something.

One little bit of advice for agoraphobia sufferers: google ‘vagus nerve’ and read about its connection to both the digestive system and the heart. This nerve can be very much involved in your feelings of faintness, as it acts on the heart and can have an effect on heart rate. When you’re out in public do you ever get a feeling of pressure in your upper abdomen, followed by a feeling of faintness? If so, be sure to tell your doctor about this and see if he thinks this is down to your vagus nerve.

And, medical men and women, please stop making assumptions about agoraphobia. There is indeed an anxiety component to this illness, but the anxiety comes afterwards, it’s a result of the illness, not the cause, at least in many cases. That there’s a physical cause for the illness itself is something about which I no longer have the slightest doubt – and I speak as someone who suffered from this illness for over 30 years but who is now cured.

[...] is/was a support group to help agoraphobics work through their issues of social interactions (http://alphavilleherald.com/2007...)Having an attractive avatar may make one more outgoing in Second Life, as well as in the real [...]